MEDICARE: RAPID CITY PHYSICAL THERAPY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	DB047346	SD

General Provider Information

NPI Number	:	1740398833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPID CITY PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	1110 W OMAHA ST STE 3
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8097
Country	:	US
Telephone Number	:	605-721-5950
Fax Number	:	605-721-5940

Provider Business Practice Location Address
First Line	:	1110 W OMAHA ST STE 3
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8097
Country	:	US
Telephone Number	:	605-721-5950
Fax Number	:	605-721-5940

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MARIAH HEATON VARCOE
Credential	:	DPT
Telephone Number	:	605-721-5950

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	09/15/2021

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